提升住院手術病人手術前訪視成效

Promotion of the Effectiveness of Pre-operative Interview for Admitted Patients

國內醫療環境在全民健保政策實施下，病人平均住院日縮短，術前準備時間相當急迫，如何在有限時間內提供個別性、系統性的護理照護，則有賴於術前訪視作業的持續推展，以達到手術全期照護的效益。本專案旨在提升住院手術病人之手術前訪視的執行率及病人之滿意度。於2012 年07-09 月間，術前訪視執行率為66.1%，深入調查原因主要為手術排程於20：00 後才可確定訪視對象，而夜班人力現場調度困難及病人不在等因素。另外，護理師僅用口頭及衛教單張輔助執行術前訪視，使病人無法清楚了解，其術前訪視滿意度結果為85.5%。擬定解決策略包括：與照護團隊共同修訂術前訪視流程及增加訪視時段、製作多媒體圖片、影片及海報及制定術前訪視監測作業，經實施後，術前訪視執行率提升至87.3%、術前訪視平均滿意度提升至96.4%，顯示透過介入措施後確實能提升住院病人術前訪視之成效，進而提升照護品質。

The medical environment is getting difficult under the implementation of National Health Insurance. The average admission days are shortened, and, thus, the time left for pre-operation prepare is very limited. How to provide personalized and systematic nursing care under such critical condition depends on the promotion of pre-operative interview to reach the goal of comprehensive care throughout the whole operation. This proposal aimed to increase the effectiveness of pre-operative interview for admitted patients. During July to September of 2012, the pre-operative interview performance rate was 66.1%. The reasons behind this relative low rate included late confirmation of operation schedule, which was usually after 8 pm, absence of patients, and low man power during night shift. In addition, pre-operative education was usually conducted verbally or through education sheet, which sometimes was insufficient, leading to a relatively low satisfactory rate of 85.5%. After the project, which comprised of revising the flow of pre-operative interview, increasing the available time for interview, applying multimedia pictures, movies and posters, and setting up quality monitor system, the pre-operative interview peformance rate increased to 87.3% and the satisfactory rate increased to 96.4%. Our study clearly demonstrated that through our improving procedures, the effectiveness of pre-operative interview could be increased, leading to improved quality of care.